Synopsis
Imaging following
shoulder instability surgery depends on suspected pathology. Direct
anatomic repair of labral tears may be perfomed in conjunction with capsular
shift. There should be no separation of the labrocapsular complex and glenoid
margin with intact labral repair. Overall accuracy of MR arthrography for
detecting labral tears after prior instability repair is > 90%. Arthroscopic Bankart repair may be performed
in conjunction with remplissage procedure in patients with engaging Hill-Sachs
lesion. MRI will show reattachment of posterior structures into the defect,
along with anchor embedded in the trough. Postoperative imaging of Laterjet
procedure must assess incorporation of the bone block and any recurrent
imaging features of instability.Imaging following
shoulder instability surgery depends on the suspected pathology and includes
radiographs, magnetic resonance imaging (MRI) or MR arthrography, computed
tomography (CT) and CT arthrography. Direct anatomic repair of labral tears usually
occurs by suturing the anterior labrum and joint capsule, and the anterior band
of the inferior band of the inferior glenohumeral ligament (IGHL) to the
glenoid rim. Repairs may be perfomed in conjunction with a capsular shift
procedure, with tightening of a capacious joint capsule. With MRI or MR
arthrography, there should be no separation of the labrocapsular complex and
glenoid margin with in intact labral repair. Capsular thickening with an
irregular nodular contour is an expected postoperative finding of capsular
repair. Comparison with prior MRI
studies is of utmost importance to evaluate for retear. The overall accuracy of
MR arthrography for detecting labral tears after prior instability repair
varies in the literature, but is generally greater than 90%. Granulation tissue within a repaired labral
tear may prevent joint fluid or contrast from outlining a persistent defect,
resulting in a false negative MR examination. Arthroscopic Bankart repair after
recurrent anterior shoulder dislocation may be performed in conjunction with
the remplissage procedure in patients with an engaging Hill-Sachs lesion. The
remplissage technique transfers the posterior capsule and infraspinatus tendon
into the Hill-Sachs lesion in order to prevent engagement of the lesion on the
glenoid rim. MRI will show reattachment
of the posterior structures into the defect, along with the metallic or bioabsorbable
anchor embedded in the trough. Postoperative imaging in
patients with recurrent anterior shoulder instability may be helpful in those who have
undergone procedures
addressing a deficient anterior
inferior glenoid. The Latarjet (also known as Laterjet-Bristow) procedure involves transfer of the tip of the coracoid process along with the
conjoined tendon through a horizontal slit in the subscapularis to the
anteroinferior glenoid neck. The transferred short head of the biceps and coracobrachialis serve as a dynamic buttress across
the anteroinferior glenohumeral joint when
the shoulder is abducted and externally
rotated. Postoperative imaging of the Laterjet procedure (and
modifications of this technique) is aimed at assessing
incorporation of the bone block and any recurrent imaging
features of instability.
Acknowledgements
No acknowledgement found.References
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